Personalised immunomodulating treatments for Graves’ disease: fact or fiction?
Although Graves’ disease has been recognised for more than 100 years, its physiopathological mechanisms are incompletely understood. Treatment strategies today mainly focus on suppression of thyroid hormone production by use of antithyroid drugs or radio-iodine, but neglect the underlying immunolo...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2017-08-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2338 |
| _version_ | 1797979688248803328 |
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| author | Tristan Struja Alexander Kutz Stefan Fischli Christian Meier Beat Mueller Philipp Schuetz |
| author_facet | Tristan Struja Alexander Kutz Stefan Fischli Christian Meier Beat Mueller Philipp Schuetz |
| author_sort | Tristan Struja |
| collection | DOAJ |
| description |
Although Graves’ disease has been recognised for more than 100 years, its physiopathological mechanisms are incompletely understood. Treatment strategies today mainly focus on suppression of thyroid hormone production by use of antithyroid drugs or radio-iodine, but neglect the underlying immunological mechanisms. Although Graves’ disease is often seen as a prototype for an autoimmune mechanism, it is more likely to be a heterogeneous syndrome showing characteristics of both autoimmunity and immunodeficiency. The interplay of these two mechanisms may well characterise the physiopathology of this disease and its complications. Immunodeficiency may be either genetically determined or secondarily acquired. Various triggering events lead to autoimmunity with stimulation of the thyroid gland resulting in the clinical syndrome of hyperthyroidism. Also, relapse risk differs from patient to patient and can be estimated from clinical parameters incorporated into the Graves’ Recurrent Events After Therapy (GREAT) score. Accurate risk stratification may help to distinguish high-risk patients for whom a more definitive treatment approach should be used from others where there is a high probability that the disease will recover with medical treatment alone. Several smaller trials having found positive effects of immunosuppressive drugs on recurrence risk in Graves’ disease; therefoore, there is great potential in the use of novel immunomodulating drugs in addition to the currently used antithyroid drugs for the successful treatment of this condition. Further in-depth exploration of susceptibility, triggering factors and immunological mechanisms has the potential to improve treatment of Graves’ disease, with more personalised, risk-adapted treatment strategies based on the different physiopathological concepts of this heterogeneous condition.
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| first_indexed | 2024-04-11T05:42:46Z |
| format | Article |
| id | doaj.art-be24a6890f244a26b3c1c2d76379f504 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-11T05:42:46Z |
| publishDate | 2017-08-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-be24a6890f244a26b3c1c2d76379f5042022-12-22T04:42:22ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972017-08-01147313210.4414/smw.2017.14476Personalised immunomodulating treatments for Graves’ disease: fact or fiction?Tristan Struja0Alexander Kutz1Stefan Fischli2Christian Meier3Beat Mueller4Philipp Schuetz5Medical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, SwitzerlandMedical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, SwitzerlandMedical Clinic, Department for Endocrinology, Diabetes and Metabolism, Kantonsspital Luzern, SwitzerlandDivision of Endocrinology, Diabetes and Metabolism, University Hospital and University Basel, Switzerland; Medical Faculty of the University of Basel, SwitzerlandMedical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, Switzerland; Medical Faculty of the University of Basel, SwitzerlandMedical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland Although Graves’ disease has been recognised for more than 100 years, its physiopathological mechanisms are incompletely understood. Treatment strategies today mainly focus on suppression of thyroid hormone production by use of antithyroid drugs or radio-iodine, but neglect the underlying immunological mechanisms. Although Graves’ disease is often seen as a prototype for an autoimmune mechanism, it is more likely to be a heterogeneous syndrome showing characteristics of both autoimmunity and immunodeficiency. The interplay of these two mechanisms may well characterise the physiopathology of this disease and its complications. Immunodeficiency may be either genetically determined or secondarily acquired. Various triggering events lead to autoimmunity with stimulation of the thyroid gland resulting in the clinical syndrome of hyperthyroidism. Also, relapse risk differs from patient to patient and can be estimated from clinical parameters incorporated into the Graves’ Recurrent Events After Therapy (GREAT) score. Accurate risk stratification may help to distinguish high-risk patients for whom a more definitive treatment approach should be used from others where there is a high probability that the disease will recover with medical treatment alone. Several smaller trials having found positive effects of immunosuppressive drugs on recurrence risk in Graves’ disease; therefoore, there is great potential in the use of novel immunomodulating drugs in addition to the currently used antithyroid drugs for the successful treatment of this condition. Further in-depth exploration of susceptibility, triggering factors and immunological mechanisms has the potential to improve treatment of Graves’ disease, with more personalised, risk-adapted treatment strategies based on the different physiopathological concepts of this heterogeneous condition. https://www.smw.ch/index.php/smw/article/view/2338aetiologyGraves’ diseasepathophysiology |
| spellingShingle | Tristan Struja Alexander Kutz Stefan Fischli Christian Meier Beat Mueller Philipp Schuetz Personalised immunomodulating treatments for Graves’ disease: fact or fiction? Swiss Medical Weekly aetiology Graves’ disease pathophysiology |
| title | Personalised immunomodulating treatments for Graves’ disease: fact or fiction? |
| title_full | Personalised immunomodulating treatments for Graves’ disease: fact or fiction? |
| title_fullStr | Personalised immunomodulating treatments for Graves’ disease: fact or fiction? |
| title_full_unstemmed | Personalised immunomodulating treatments for Graves’ disease: fact or fiction? |
| title_short | Personalised immunomodulating treatments for Graves’ disease: fact or fiction? |
| title_sort | personalised immunomodulating treatments for graves disease fact or fiction |
| topic | aetiology Graves’ disease pathophysiology |
| url | https://www.smw.ch/index.php/smw/article/view/2338 |
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